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HomeMy WebLinkAboutMiscellaneous - 1160 GREAT POND ROAD 4/30/2018 (51) x _ r t i• l - < t F I r � n - c i .f f s S _ < _ 1. ' t r� F _ "i Y - .._. : - _ x n' t. .. .: _ , . -y. .: - -, , .- -.i. `. .,1 f {` [ f .:. .., . . :r _ _ _ _ 4 S - - Y V 't .. .- .. ..-. _ .. - , `, ..: ,k 1' Date.... f NGRTM� "�,� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING �,SSACMUS� This certifies that �41e/.Q....... � has permission to perform ....LDA �. q ?O.t fi ...CDv7lLF%5 .... ..... .......... . v wiring in the building of......131?0�.f4 5..... /bac' /:.................... at.....1 /90..�! L � �/l..Q.�................ . rth Andover,Mass. -© o1�963� Fee..$.........".0.... Lic.No.............. ......................... . . .............!�ZGI,c' 4 ELECTRICAL INSPECTOR 1 Check # a 6 % 6v r = Commonwealth of Massachusetts Official Use Only �,7 tF • l'�'�--�=�u� Permit No. 6 Department of Fire Services Occupancy and Fee Checked Ct` +'' BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/99) (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAU WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: —3-64- f'ity or Town of: �r To tllr In.:nr r tnr of By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) /40 Owner or Tenant /91?6aKJ J'CeA,jL AQLy,,1 aOe Lfeyo~,194a elephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ®�o ❑ (Check Appropriate Box) Purpose of Building Utility Authorisation No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Set-vice Amps / Volts Overhead❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the followin,4/able mai,be waived bi,the Inspector of ID•ires. No. of Recessed Fixtures No.of Ceil.-Susp.(Paddle) Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No.'of Lighting Fixtures Swimming Pool Above rnd. 11In-rnd. ❑ o. o Battery Units Units cy tg tmb No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches y No. of Gas Burners No. of Detection and InitiatingDevices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump NumberTons KW No. of Self-Contained totals: I I Detection/Alertin-, Devices No. of Dishwashers Space/Area Heating I(W Local ❑ Nlunicipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems: i No.of Devices or Equivalent No. of Water No. of No. of 1 Heaters KW Data Wiring: Sivns Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or E uivalent OTHER: Attach additional detail if desired,or as required by the Inspector of{Vires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such ves • --in force, and has exhibited proof of same to the permffic it issuing oe. CHECK ONE: INSURANCE coBOND ❑ OTHER ❑ (Specify:) s. (Expiration Date) Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: '-70-9-7d'9 Inspections to be regwested in accordance with MEC Rule 10, and upon completion. I certify, under the pains and penalties of perjury, that the information on this application is true and complete. �,�? FIRM NAME: (/i 0 �G7C-�� �� cr1 G LIC. NO.: �W7 34 Licensee: 04016, 11,4.6 0a-& Signature �- LIC. NO.: (If applicable, enter "e.rempt"in the license number line,,) Address: Bus. TeL No.:9�Y 6f32-roL�Z ZSC-Q,ct7� sT �RIT/•2�IC� / ��d L7 Alt. Tel. No.:97r 3-7 S' s-73�V OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one)❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. [PERMIT FEE: S TOWN OF NORTH ANDOVER NORTH APPLICATION FOR PLAN EXAMINATION 0 q oit A Permit NO: a- Z2 _ OG Date Received r� 7 RAT/D Date Issued: �' _d 9SSACHU`��� IMPORTANT: Applicant must complete all items on this page LOCATION l 6 t►-eat r 6Y)d Rd- Print d Print PROPERTY OWNER 6''-001-5 Schoa Print MAP NO.: �y 3 PARCEL: g ZONING DISTRICT: n 57�, TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ❑New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial 6e Alteration No. of units: ❑Repair,replacement ❑ Assessory Bldg ❑Commercial ❑Demolition ❑Moving(relocation) ❑Other M Others: nsf,tv of P ❑Foundation only DESCRIPTION OF WORK TO BE PREFORMED &---Y7c-105e a l-7 toadono, do k son room Identification Please Type or Print Clearly) OWNER: Name: 9r0,,1 k-5 SS J10 U I Phone: 779 Address: //6a great PovIC/ 4 CONTRACTOR Name: Co h Sfl'v L h o►) Phone:(( ) a 3 y•6 76k Address: 75-D Z--- , -h4y9trIct f Park Or, Man JieS-fer A/ Supervisor's Construction License: C.S 093819 Exp. Date: a l -3f 0 7 Home Improvement License: ,, Exp. Date: ARCHITECT/ENGINEER l V/o np Name: Phone: Address: Reg. No. FEESCHEDULE. BULDINGPERM17 $12.00 PER$1000.00 OF THE TOTAL ESTIMATED C ST BASED ON$125.00 PER S.F. Total Project Cost :$ SO n = FEES 4 Check No.: 9, 3� Receipt No.:--i Page 1 of 4 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding,Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work Addition Or Decks ❑ Building Permit Application ❑ Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Page 4 of 4 1 Building Setback (ft.) Front Yard Side Yard Rear Yard Required Provided Required Provides RequiredProvided Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: NOTES and DATA— (For department use Page 3 of 4 Doc:INSPECTIONAL SERVICES DEPARTM ENT:BPFORM05 Created JMC.Jaa.2006 r. TYPE OF SEWERAGE DISPOSAL Swimming Pools ❑ F1Tanning/Massage/Body Art ❑ Public Sewer Well Tobacco Sales ❑ Food Packaging/Sales El❑ ❑ Permanent Dumpster on Site El Private(septic tank,etc. Electric Meter location to project NOTE: Persons contractstlyur a istered contractors do not have access to the guars fund Signature of Agent/OAe a h 1 Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF-U FORM DATE REJECTED DATE APPROVED PLANNING& DEVELOPMENT ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ ` COMMENTS FIRE DEPARTMENT - Temp Dumpster on site yes_ J no Fire Department signature/date COMMENTS Zoning Board of Appeals: Variance,Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water&Sewer connection/Signature&Date Driveway Permit P11 VIP! f$C- Location/06 �lt�rn � "" c)0Aj% -,1()P A- No. �2 Date NORTq TOWN OF NORTH ANDOVER F D + ; : Certificate of Occupancy $ �'�J'••�•;<� Building/Frame Permit Fee $ � ncwus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ } Check 196,13 Building Inspector F NDS M Town of : ove r 0% No. Z F o A o dover, Mass., • COCKICMEWICK IF 7�ADRATED `s BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System ' BUILDING INSPECTOR . THIS CERTIFIES THAT. r.a.a� �i1 .... l.�.............�.11�N.1.....�44 .�.................................. Foundation has permission to erect........................................ buildings on ./16_40 .16_40..... r".1.P h .. .�......... Rough to be occupied as.,�i�..rw.I*�.......#Af..r*........ �.�i►�w.�...�h. .... ! .`.. ✓..�h.....� Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final 5 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU T S Rough ... Service B DING IN I'OR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE j Smoke Det. � Lp1W� IOJIR,:: BOARD OF T1ON supEF?dl License: CONSTRUC :C5 oa3ala Number k '� �� B►rthd"ate" 0211311955 83g{8' ' ' Ex�res 0211.312007 STEVEN E WHALEN �a ,,o,, # W HIGHWA'�#5 Adm�m�stratorY ,MED The Commonwealth of 1lassachuselts Department of IndustrialAccidents accidents q Office of Investigations 600 Washington Street Boston, .SIA 02111 www.mass.gov/dia Workers' Compensation Insurance ,affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information / 1 Please Print Legibly ' ane(l3usincss;Urgani;,tion Intli�iklual): k e- ��l �ph s—"ru, -/O r) Address: 75-0 E, Tn d u s t- lg l PA r-k Dr i1 -e _ City;State,,Zip: Ma inn h s+er 661 Y e) aAVhone#: 603 &X7 gd,O 3 Are you an employer?Check the appropriate box: Type of project(required): 1.91 1 am a employer with /-5- 4• ❑ I am a general contractor and 1 6. ❑ New construction employees(full and/or part-tune).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. ' 2 Remodeling ship and have no employees These sub-contractors have 3. ❑ Demolition working for me in any capacity. workers' comp. insurance. y. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.]t employees. [No workers' 13.❑ Other comp. insurance required.] `Any applicant that checks box fl must also lilt out the section below showing their workers'compensation policy information. `I lomeowncrs who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional:,beet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my emplgyees. Below is the policy and job site information. Insurance Cumpany Name: 17�_ C Dt di Policy 'f or Self-ins. Lic. 4:A�)�Q�1_ � - I( —`— —__ Expiration Date'':/_ 0 Job Site Address:. H&D GIV P9 T �Gn4 Rel. City;'StateiZip:_dV ,All t1g o 1 S9 S . ,attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition ofcriminal penalties of a tine up to 51,500.00 and/or one-,year imprisonment,as well as civil penalties in the form of STOP WORK ORDER and a tine Of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi/ itler the ni s run enalties of perjury that the information provided above is true and correct. �.imttll e: [late: 912- (0 2 t?/ficial use only. (Oo r:ol trrile i►►this rrr<`u,!rl hc .v,mplctcd by r-rip;rr tatwt,,�ficiul. City or Town: Permit/License 4 _ Issuing,Authority(circle one): I. Board of Health 2. Building Department 3.City/Town Clerk A. E!ectrical Inspector 3. f lurnbing Inspector 6.(:Other Contact !'rr r,a�: --- —_ _— Phone 4: -.-------------- JOB KELLY CONSTRUCTION CO., INC. SHEET NO: OF 750 East Industrial Park Drive MANCHESTER, NH 03109 CALCULATED BY DATE (603) 627-4203 CHECKED BY DATE FAX (603) 627-3460 SCALE ..................._'V ... �. !-� .. �.9U c i.�. - , _.. ._.... .. _..... ..... (D ' <-S3 .... ._ C ........ G Cy O r,0 � � c PRODUCT 2044(Single Sheets)2054(Padded)